Appendix 1. Specifications for identifying subsequent breast cancer STEP 1: Identification of second primary breast cancer Identification based on key variables from Cancer Registry including date of diagnosis; stage of second primary; laterality; histology and sequence number. STEP 2: Identification of recurrence (local, regional or distant metastases) based on electronic health record algorithm using automated databases: Disease recurrence identified by breast cancer ICD9 diagnosis of 174.xx or 233.0 or 155.xx or 162.xx or 163.xx or 170.xx or 191.xx or193.xx or 194.xx or 195.xx or 196.xx or 197.xx or 198.xx or 199.xx or 212.xx or 213.xx or 255.xx or 239.0 or 239.1 or 239.2 or 239.3 or 239.6 or 511.81 or 733.1x or (CDAP, KP code of 1083, 3690, 3691) or ICD10 C50 (at least six months after the index cancer AND after 1st primary surgery) OR (six months after 1st chemotherapy) PLUS any of the below procedure codes occurring +/- 30 days from the date of the ICD9 disease code: BIOPSY/IMAGING/SURGERY : 10021 Biopsy, superficial fine needle aspiration without imaging guidance 10022 Fine needle aspiration; with imaging guidance 19100 Biopsy of breast, percutaneous core, without imaging guidance 19101 Biopsy of breast; open incisional 19102 Biopsy breast percutaneous core needle w ultrasonic guidance 19103 Biopsy breast; perc-vacuum dev w/imaging 19295 Imaging guided plc clip-perc-dur breast 19301 Mastectomy, partial 19302 Mastectomy, partial; with axillary lymphadenectomy 19303 Mastectomy, simple, complete 19304 Mastectomy, subcutaneous 19305 Mastectomy, radical, including pectoral muscles, axillary lymph nodes 19306 Mastectomy, radical, including pectoral muscles, axillary and internal mammary lymph nodes 19307 Mastectomy, modified radical, including axillary lymph nodes, w/ w/out pectoralis minor muscle, but excluding pectoralis major muscle 19340 Immediate insertion of breast prosthesis following mastectomy 19342 Delayed insertion of breast prosthesis following mastectomy 19357 Breast reconstruction, immediate or delayed, with tissue expander, including subsequent expansion 19361 Breast reconstruction with latissimus dorsi flap, with or without prosthetic implant 19364 Breast reconstruction with free flap 19366 Breast reconstruction with other technique 19367 Breast reconstruction with TRAM, single pedicle, including closure of donor site 19368 Breast reconstruction with TRAM, single pedicle, including closure of donor site; with Microvascular anastomosis 19369 Breast reconstruction with TRAM, double pedicle, including closure of donor site 20220 Biopsy superficial bones with trocar or needle 20225 Biopsy deep bones with trocar or needle 20999 Biopsy of bone other
32095 Open biopsy of lung or pleura (Limited without exploration) 32100 Open biopsy of lung or pleura with exploration (Major) 32405 Percutaneous biopsy of lung or mediastunum (Transthoracic) 36011 Selective catheter of liver 37200 Transcatheter biopsy of liver 38221 Biopsy of bone marrow 47000 Percutaneous needle biopsy of liver 47100 Open biopsy of Liver also called wedge biopsy 61793 Stereotactic radiosurgery (particle beam, gamma-ray, linear accelerator),one or more sessions 75970 Transcatheter biopsy S/I of Liver 76098 XR surgical specimen 76400 Magnetic image, bone marrow 76942 ECHO guide for biopsy 76645 ECHO exam of breast(s) 77002 Fluoroscopic guidance for needle placement, injection or asp 77011 CT guidance for stereotactic localization 77012 CT guidance for needle biopsy 77021 MRI Guidance for needle placement; Rad supervision & interpretation 77031 XR mammogram, stereotactic loc 77032 Mammographic guidance needle placement ea lesion of breast, 77051 Computer-aided detection, w/or w/o radiographic images; diagnostic mammography 77052 Computer-aided detection, w/or w/o radiographic images; screening mammography 77053 XR mammary ductogram single duct, right 77054 ductogram, multiple duct 77055 XR mammography, diagnostic 77056 Mammography diagnostic, bilateral 77057 XR mammogram, screening 77058 MRI Breast w/and/or w/o contrast unilateral 77059 MRI Breast w/and/or w/o contrast bilateral 77432 Stereotactic radiation treatment management of cerebral lesion(s) 78102 Bone marrow imaging, limited 78103 Bone marrow imaging, multiple 78104 Bone marrow imaging, whole body 78201 Liver imaging 78202 Liver imaging w flow 78205 Liver imaging spect 78206 Liver imaging spect w vascular flow 78300 Bone or joint imaging ltd 78305 Bone or joint imaging multiple 78306 Bone scan whole body 78315 Bone scan 3 phase study 78320 Bone joint imaging tomography test spect 78600 Brain imaging ltd static 78601 Brain ltd imaging and flow 78605 Brain imaging complete 78606 Brain imaging complete w flow 78607 Brain imaging spect 78610 Brain flow imaging only 78608 Brain imaging, positron emission tomography (pet) metabolic evaluation 78609 Brain imaging, positron emission tomography (pet), perfusion evaluation
: Breast biopsy 85.11 Closed breast biopsy 85.12 Open breast biopsy 85.21 Local excision breast lesion 85.22 Quadrant resect breast 85.23 Subtotal mastectomy Lymph node removal 40.23 Excise axillary node 40.29 Simple excise lymph strucnec 40.3 Regional lymph node exc Mastectomy 85.41 Unilateral simple mastectomy 85.42 Bilateral simple mastectomy 85.43 Unilateral Extend simple mastectomy 85.44 Bilateral Extend simple mastectomy 85.45 Unilateral radical mastectomy 85.46 Bilateral radical mastectomy Liver Biopsy 50.11 Closed (percutaneous, needle, biopsy of liver) 50.12 Liver biopsy, open Lung Biopsy 33.26 Closed [Percutaneous] [Needle] Biopsy of Lung 33.27 Closed Endoscopic Biopsy of Lung 33.28 Lung Biopsy, Open Bone Biopsy 77.40 Bone biopsy nos 77.41 Chest cage bone biopsy 77.42 Humerus biopsy 77.43 Radius & ulna biopsy 77.44 Metacarpal/carpal biopsy 77.45 Femoral biopsy 77.46 Patellar biopsy 77.47 Tibia & fibula biopsy 77.48 Metatarsal/tarsal biopsy 77.49 Bone biopsy nec Bone Marrow Biopsy 41.31 Bone marrow biopsy Brain Biopsy 01.13 Closed brain biopsy 01.14 Open brain biopsy Imaging
88.91 MRI brain & brain stem 92.02 Liver scan and radioisotope function study 92.14 Bone scan CYTOLOGY 32000 Thoracentesis, puncture of the pleural cavity for aspiration, initial or subsequent 32002 Thoracentesis with insertion of tube, includes water seal, when performed (separate procedure) 32400 Biopsy, pleura; percutaneous needle 32421 Thoracentesis, puncture of the pleural cavity for aspiration, initial or subsequent 32422 Thoracentesis with insertion of tube, includes water seal, when performed (separate procedure) 88112 Cytology Respiratory Tract (Sputum, Bronchial, Wang Needle, Pneumocystis) 88142 Body Cavity (Pleural, Peritoneal, and Pericardial fluid) 88161 Cytology Respiratory Tract (Sputum, Bronchial, Wang Needle, Pneumocystis) 88173 Fine Needle Aspiration Pleural Fluid 34.91 - Thoracentesis (pleural fluid analysis) CHEMOTHERAPY (At Least 6 Months after 1st Chemotherapy): 96400-96499 Chemotherapy 96500-96599 Chemotherapy 99.25 Oral Chemo Agents Abraxane (Paclitaxel) Bevacizumab (Avastin) Busulfan Capecitabine (Xeloda) Carboplatin Cyclophosphamide Docetaxel Docetaxol (Taxotere) Doxorubicin Epirubicin Etoposide Fluorouracil Fulvestrant Gemcitabine Liposome Doxorubicin Melphalan Methotrexate (Oral Injection Only, Not Tablets) Paclitaxel (Taxol) Rhumab-Vegf Rituximab
Temozolomide Vinorelbine RADIATION THERAPY (If didn't receive radiation therapy as 1st course of treatment) 77261-77299 Radiation therapy 77300-77399 Radiation therapy 77401-77499 Radiation therapy 77520 Radiation therapy 77523 Radiation therapy 77750-77799 Radiation therapy 76370 Radiation therapy 76950 Radiation therapy G0256 Radiation therapy G0261 Radiation therapy 92.21-92.29 OTHER INDICATORS OF RECURRENCE Disease recurrence identified by breast cancer ICD9 diagnosis of 174.xx or 233.0 or 155.xx or 162.xx or 163.xx or 170.xx or 191.xx or193.xx or 194.xx or 195.xx or 196.xx or 197.xx or 198.xx or 199.xx or 212.xx or 213.xx or 255.xx or 239.0 or 239.1 or 239.2 or 239.3 or 239.6 or 511.81 or 733.1x or (CDAP, KP code of 1083, 3690, 3691) or ICD10 C50 at least 12 months after the index cancer AND after 1st primary surgery PLUS any of the below utilization categories occurring +/- 60 days from the date of the ICD9 disease code: Oncology Visits(Clustering of quarterly oncology visits/hospitalizations) If patient has more than 1 visit within a three month period more than a year after initial diagnosis. Drug Switching from Tamoxifen to AI If long break (12+ Months) in TAM therapy and then therapy resumes (AI). Hospice/Palliative Care Utilization If encounter for hospice/palliative care (ICD code V66.7) or physician supervision of a hospice patient (CPT 99377). Pain Medication Utilization (Prescribed by Oncologist) Opioids/Narcotics STEP 3: Distinguish identification of recurrences from second breast primary cancers Identify first surgery date after initial breast cancer Dx (from cancer registry, pathology, electronic databases). Compare date of procedure used to identify recurrence to that of first surgery date. If procedure occurs before 1 st surgery, should NOT be considered a recurrence. If the date of second primary breast cancer (from cancer registry) is within 30 days of the recurrence, ignore recurrence and code as a second primary.